The Medical waste disposal program took in expired drugs from people who brought them to the Marin Civic Center for earth day On Tuesday April 22 2008 in San Rafael, Calif
Photo By Kurt Rogers / San Francisco Chronicle

Photo: Kurt Rogers

The Medical waste disposal program took in expired drugs from...

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medical waste program at the Marin Civic Center Niyati Desai of Teleosis Robert Turner of Environmental Health Services Marin County and Carolyn Beoris with Integrated Waste Control run the drug take back program. On Tuesday April 22 2008 in San Rafael, Calif
Photo By Kurt Rogers / San Francisco Chronicle

Pittsburg resident Maggie Dee Dowling used to flush her expired medications down the toilet, but decided to take them back to her local Walgreens after hearing that traces of prescription drugs have been found in drinking water. She was stunned when the pharmacy refused to accept them.

"The pharmacy tech opened the brown paper bag and said, 'What do you want us to do with it?' " said Dowling, 68, adding that the drugs she tried to drop off about a week ago included an inhaler and some anti-diarrheal pills.

The experience left Dowling frustrated and unsure of what to do with her unwanted medications. "It just seems to me that with all the things we're doing to pollute the Earth, if I can in some small way do my part in not flushing pollutants down the drain, then I was all for it," she said.

Consumers are rightly confused about what to do with their unwanted medications because they've received conflicting messages from government and environmental sources. Federal guidelines direct consumers which medications to flush and how to properly put others in the trash. But landfills can leak, potentially causing drugs to leach into the soil, and flushing has contaminated waterways.

As a result, trace amounts of medications have been found in drinking-water supplies, causing growing concern about the effect of those drugs on aquatic life and humans.

Most drugs enter water sources when they are flushed down the toilet or people pass the substances through their system. While wastewater is treated before it is reintroduced to rivers and streams, most treatments do not remove all chemical residues.

The Associated Press in March reported the results of a five-month investigation, which found that the drinking water in 24 major metropolitan areas contained a variety of prescription medicines in low concentrations.

The drugs included sex hormones, antibiotics, mood stabilizers, anti-convulsants and many others. The effect on humans is unknown.

In response to Dowling's experience, a Walgreens spokeswoman said the employee responded appropriately because the company does not have a take-back program but instead encourages customers to follow federal guidelines.

Federal guidelines suggest mixing drugs with an unappealing substance, such as coffee grounds or kitty litter, and putting them in nondescript containers to prevent people from finding them in the trash. The Food and Drug Administration also advises people to flush rather than throw away controlled substances such as Oxycontin, Percocet, Valium and Vicodin.

'No-win situation'

But environmental health advocates disagree with those options. "At this point, you have to stockpile them, but that's not without its danger in terms of substance abuse. It's kind of a no-win situation," said Bryan Early, policy associate Californians Against Waste, a Sacramento environmental group.

Local government pharmacy take-back programs, which encourage people to take their unwanted drugs to their pharmacy for disposal, and one-day events are consumers' best option, Early said. But this potential solution isn't available in all areas.

Because federal law requires that law enforcement personnel be present when controlled substances such as narcotics are received, some pharmacies have been reluctant to accept medications. The fear is that a thief or unscrupulous employee would steal the drugs for personal use or to sell.

Concerned pharmacists in Marin County helped start the state's first drug take-back program in 2004, said Fred Mayer, education chairman for the Marin County Pharmacists Association. Other counties and states have instituted take-back programs.

Marin County's program offers pharmacies locked containers to store the pharmaceuticals and contracts with Integrated Waste Control, a medical waste transport and treatment company, to pick up and destroy the products. Currently, 17 Marin County pharmacies, including some major chains like Walgreens and Longs Drugs, accept noncontrolled substances.

At an Earth Day event Tuesday, Marin County's medical waste program collected more than 200 pounds of unwanted medications from county employees, said Rick Vasquez, president of Integrated Waste Control, which is in Hayward.

Vasquez said the drugs will be taken to a waste energy plant incinerator in Utah because no such facilities exist in California, due to air quality laws.

Teleosis Institute, a Berkeley organization that promotes sustainable medical practices, collected data on the Marin County event as part of a larger effort to find out what drugs people are throwing out and why. The group hopes to encourage more pharmacies and, in particular, drug manufacturers to participate in the cost of drug-disposal programs.

Green pharmacy program

Teleosis last year started a Green Pharmacy program, which to date has collected more than 1,000 pounds of unused drugs at 15 take-back sites throughout the Bay Area, said Evin Guy, manager of the program.

Legislative efforts are starting to address the problem. Gov. Arnold Schwarzenegger in October signed into law a bill expected to ultimately produce a model drug-disposal program to be used statewide, but the process is early in development.

Robert Turner, senior registered environmental health specialist in charge of Marin County's medical waste program, said drug and needle take-back programs help reduce the environmental impact. But he hopes future solutions will address the need for affordable drugs.

"What we're doing is a first step, but after that we need to try to get to a position where we can make these available to Third World countries or to our own needs," Turner said.

Don't flush drugs down the toilet

Studies have shown about 54 percent of consumers put unwanted medications in the trash and 35 percent flush them down the toilet. Prescription drugs have been detected in our drinking-water supplies. Here are some do's and don'ts about what to do with unused drugs: